Directions
Member Directory
Member News
Member Publications
Officers and Committee   Chairs
Other Resources
Previous Meetings
 
 
 

 

 

 

 

Online Questionnaire for Group Therapy Listing

In order to have your groups listed, you must be a current paid-up member of WGPS.

Part I: Professional Information

Name:

Degree:

Telephone:

Email:

Office Address:

City: Zip:

Are you licensed for independent practice? Yes No

License No

AGPA Member:

Are you a Certified Group Psychotherapist (CGP)?

Part II: Current on-going groups you are leading:

1. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

2. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

3. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

*Sample Listing:
1.    Type of Group*: Eating disorders
       Age Range:   20’s – 40’s        Gender: Women   
       Frequency of Group:     1x weekly – ongoing
       Where does the Group meet?       Ossining
       When does the Group meet? (Day and time):Tuesday 730-900pm

** Overall categories will include: Children and Adolescent, Adult, Training and Supervision etc.
*** If you plan to start a group, provide us with as much detail as you can and we will list it as a pending or with a target date.

There will be a disclaimer posted on the WGPS website that this listing is for informational purposes only and that this particular therapist should be called for detailed information.

I request that WGPS post the above information about my group(s) on www.WGPS.org .

 

Signature: